Liver transplantation (OLT) is now accepted as an effective therapy for a variety of otherwise untreatable acute and chronic liver diseases. The success and broadened indications for OLT have resulted in a growing disparity between the number of potential recipients and the limited availability of donor organs. During the past decade, research has documented the efficacy of OLT and survival models have been developed for cohorts of patients with primary biliary cirrhosis and primary sclerosing cholangitis (PBC and PSC). The ultimate need for organ transplantation prior to the development of end stage liver disease in PBC and PSC patients can be predicted. A continuing challenge for OLT, as a discipline, is to more precisely define and predict its effects for individual subjects, both for the selection and timing of this important therapeutic procedure. Currently, there are three important needs and opportunities in this area as follow: 1) broaden the scope of models to include patients with chronic hepatitis C and alcoholic liver disease; 2) move from models based upon cohorts of patients to those focused on individual patients, and 3) more thoroughly investigate previously identified risk factors, such as malnutrition, in order to better understand their impact on patient outcome and health care expenditures. Health care reform will increasingly demand greater accountability for economic efficiency, maintenance of quality of medical care, and the apportionment of limited resources to those patients who will optimally benefit. This research is intended to establish models that will provide objective data to assist patients, physicians and third party carriers in making crucial medical and health policy decisions.